CT is overused in diagnosing dental infections in ERs

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The use of computed tomography for dental infections—common for a large percentage of emergency department cases—is overused, posing health risks and boosting costs.

That’s the result of a recent study published in this month’s issue of the Journal of Oral and Maxillofacial Surgery.

Nearly half of all patients presenting with odontogenic, or dental, infections, underwent unneeded CT scans, according to the study, which assessed the cases of 470 adult patients.

Researchers found unnecessary scans were most common in patients who had low-risk infections. Among those patients, 78.2 percent of the 284 CT scans were found to be unnecessary.

Medical imaging induces an estimated 2 percent of cancers, thus boosting risks for patients. Also, cost is another issue—the study indicates that a CT scan of the head and neck in the ZIP code where the study took place—Jacksonville, Fla.–costs an estimated $1,219 to $3,328 depending on whether a patient is in-network; by contrast, panoramic imaging costs $135, the study states.

Researchers considered a CT scan unnecessary if patients did not have a "red-flag" indication—voice change, elevated floor of the mouth, indications of inflammation of deep connective tissue spaces, swelling around the eyes, labored breathing, trismus (lockjaw) and difficulty swallowing or painful swallowing. However, researchers found a strong correlation between red-flag signs and moderate- to high-risk infections that require a CT scan to better assess health risk.

In addition, findings from history and physical exams were extremely predictive of the presence of moderate- to high-risk infections that warrant ordering a CT scan. For example, among red-flag signs, moderate- to high-risk infections were found in 100 percent of patients with voice change, 88 percent of patients with elevated floor of the mouth, 75 percent of patients with difficulty swallowing (known as dysphagia) or painful swallowing (odynophagia), and 68 percent of patients with trismus.

A CT scan also was deemed unnecessary if the infection did not spread past spaces next to the teeth. However, CT scans were ruled necessary if they were conducted on patients with the disease in a space that posed a moderate to high risk to the airway or nearby vital structures.

"Establishing guidelines to standardize ordering is the first step oral and maxillofacial surgeons can take to decrease unnecessary CT scans," researchers wrote. "Guidelines, in theory, would decrease the amount of unnecessary CT scans ordered and standardize ordering practices among providers."

The full article can be accessed here.

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